Cow's Milk Protein Allergy (CMPA)

• What is Cow's Milk Protein Allergy?


  Hypersensitivity to protein in cow's milk (not the same as lactose intolerance)

  Can be IgE mediated (reaction occurs within 2 hours if ingestion) or non-IgE mediated (reactions occur slowly, over several days)
• CMPA is more common in formula fed babies & those with personal or FHx of other atopic conditions.
• What are the signs & symptoms of CMPA?


  Usually presents before 1 yrs

  • Bloating & wind
  • Abdominal pain
  • Diarrhoea
  • Vomiting
  • Failure to thrive
  • Urticarial rash (hives)
  • Angio-oedema (facial swelling)
  • Cough or wheeze
  • Sneezing
  • Watery eyes
  • Eczema
  • Anaphylaxis (severe cases)
• NOTE: CMPA can present in breastfed babies when the mother is consuming dairy products.
• What are the RFs of CMPA?


  Hx of atopy (asthma, allergic rhinitis, atopic eczema)

  Existing food allergy

  FHx of atopy

  FHx of food allergy

  Male
• What are the possible complications of CMPA?


  Anaphylaxis

  Stress & anxiety

  Reduced QoL

  Restricted diet & malnutrition

  Development of atopic comorbidities

  Cross-reactivity of other mammalian milks

  Enterocolitis, proctocolitis & enteropathy

  Eosinophilic oesophagitis

  Heiner's syndrome
• What are the Inx of CMPA?


  Obs

  Take a focused allergy Hx

  Examination

  • nutritional status & growth
  • signs of reaction
  • signs of atopy

  Skin prick testing?
• What are the DDx of CMPA?


  Food intolerance

  Other food allergies

  Anatomical abnormalities

  Coeliac disease

  Colic

  Constipation

  IBD

  GI infection

  GORD

  IBS

  Pancreatic insufficiency (e.g. CF)
• What is the management of CMPA?


  Avoid cow's milk

  • breast feeding mothers should avoid dairy products
  • replace formula with special hydrolysed formulas for CMPA

  Every 6 months, infant can be tried on the 1st step of the milk ladder (malted milk biscuits) then slowly progressed up the ladder until symptoms develop -> overtime should progress towards a normal diet containing milk

  Most children outgrow CMPA by 3 yrs.